1306049820 NPI number — KEMIT PLLC

Table of content: (NPI 1306049820)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306049820 NPI number — KEMIT PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KEMIT PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
KEMIT MEDICAL GROUP
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306049820
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
23077 GREENFIELD RD
Provider Second Line Business Mailing Address:
SUITE 231
Provider Business Mailing Address City Name:
SOUTHFIELD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48075-3709
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-569-2160
Provider Business Mailing Address Fax Number:
248-569-5756

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23077 GREENFIELD RD
Provider Second Line Business Practice Location Address:
SUITE 231
Provider Business Practice Location Address City Name:
SOUTHFIELD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48075-3750
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-569-2160
Provider Business Practice Location Address Fax Number:
248-569-5756
Provider Enumeration Date:
06/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
ANTHONY
Authorized Official Middle Name:
DWAYNE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
248-569-2160

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  4301062274 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4221369 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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